Complementary & Alternative Therapies

Infant looking over mom's shoulder
If your child has a serious heart condition, you want access to the best medicine and doctors possible. When your child goes to a hospital in North America, she will receive conventional medicine. There are, however, other non-medical practitioners that offer treatment called complementary therapy and alternative therapy. It is important that you understand the differences between these approaches to make informed decisions about your child's care.

What is conventional medicine?

Conventional medicine refers to the health practices that are widely used by medical doctors, nurses, and other specially trained health professionals to diagnose and treat disease.

Conventional medicine is based on evidence that shows what works and what does not. For example, if researchers want to find out if a new drug is useful, they conduct a clinical trial, or study. In a trial, the drug is tested in two groups of people. One group gets the new drug. The other group gets either get a pill that has no active ingredient (placebo) or an old drug. The people in the trial do not know what they are getting. Then the researchers study the people and watch closely for improvements or problems. The drug is tested on many different people.

After the trial is finished, the researchers assess the results and write about the trial. The findings may show that the drug was effective or not, or that it has more or fewer side effects than another treatment. The researchers send their report to a journal. Experts who are not connected to the study read their report and point out any problems. If the experts agree that the trial was high quality, the report is published. Then, other researchers should be able to repeat the trial to see if they get the same results. After many trials, a drug is approved to be sold to the public.

Of course, this scientific process is not always perfect. However, at the moment it is the best way to make sure that a new treatment is safe and effective. Keep in mind that science does not proceed by "miracle breakthroughs" or "giant leaps." It moves forward carefully, taking many small steps, slowly building towards a consensus.

What is complementary therapy and alternative therapy?

Complementary and alternative therapy refers to products, techniques, theories, or practices that fall outside conventional medicine.

  • Complementary therapy is used together with conventional medicine.
  • Alternative therapy is used instead of, or as a replacement for, conventional medicine.

People may engage in complementary and alternative therapies in their everyday lives when they are healthy, or when they are very ill. Its use is considered by many to be controversial.

It is not always easy to determine what approach is complementary or alternative. This may vary according to personal opinion. For instance, in India, Ayurvedic medicine, which is based on a mind-body approach, is as widely available and trusted as conventional medicine and is an established part of the country's health system. While common in India, this approach would be considered an alternative therapy in North America.

Also, some of these therapies are more "mainstream" than others and are being studied in the same way as conventional medicine. The medical profession is increasingly exploring new approaches that show real promise.

Are these approaches effective?

Complementary therapies can in some cases be very helpful, or at least not cause harm, when used with conventional medicine. Some alternative therapies, however, are unproven and could be harmful. If alternative therapies are used in place of conventional medicine, it means someone could be missing out on the proven benefits of an effective treatment.

There is a growing body of scientific research on complementary and alternative therapies. Certain products and services have been studied in clinical trials, and have been found to be helpful in some circumstances. However:

  • Not all complementary and alternative therapies have been rigorously evaluated.
  • Some complementary and alternative therapies have shown promise, but require further investigation.
  • Some complementary and alternative therapies have been evaluated and found to be ineffective or even harmful. This can be frustrating to doctors who see their patients and their families spend significant sums of money on treatment that offers a false sense of hope.

It is important to know that doctors are always looking for new effective treatments. If a treatment seems promising and scientifically sound, it will be explored and tested in the medical arena. Rigorous research is essential to know whether a treatment helps a condition, does nothing, or worsens it.

Why do people try alternative therapies?

If there is nothing that will "cure" a child by way of conventional medicine, desperation may set in and parents become willing to entertain other ideas. This may particularly true if they have doubts to begin with that conventional medicine is the answer.

Many people also think these therapies are less "clinical," therefore more effective and safe. But that is not always the case. Some herbal remedies, for example, can have very negative effects on the body, even though they seem "natural."

Often the "proof" of a treatment is anecdotal, based on a few stories, instead of scientific. The people giving the treatments may also make false claims, even that conventional treatment will undermine what they are offering, and say they have all the answers. It can be very tempting for parents to hear all these encouraging words if they are searching for hope.

When do people consider complementary and alternative medicine?

Some families consider complementary and alternative therapies at the time of diagnosis, depending on their individual preferences and their trust in conventional medicine. Others consider alternatives when conventional treatment has failed.

Are these therapies widely used in children?

A study by the Fraser Institute indicated that about 17% of Canadian children use complementary and alternative therapies, and numbers may be higher for particular diseases or conditions. It is important to note, however, that there may be even less information on the safety of effectiveness of complementary and alternative therapies in children, since most use and studies is in adults.

What do doctors know about alternative therapy?

More and more, doctors are learning about alternative therapy. Many people use alternative therapy and ask their doctors about it, so doctors need to know about it in order to answer questions and help their patients make informed choices. Depending on their area of specialty, doctors may hear about lots of alternative therapies. They do their homework to help determine if there is any value to these treatments.

Why might a doctor hesitate to recommend alternative therapy?

  • The therapy is not based on scientific evidence or has not been studied enough: There may not be enough research to know if a therapy works or is harmful. Also, there tends to be even less information on how these therapies affect children.
  • The therapy may be harmful or could create problems with conventional treatment: Some herbal supplements, for example, even though they are natural products, can be harmful. Others may create problems when used with the conventional treatment.
  • The therapy has been studied and it does not work: In some cases, alternative or complementary medicines have been studied to see their effect on a particular problem. The clinical trial shows that the therapy does not work at all.

Who provides complementary and alternative therapy?

Many different people provide complementary and alternative therapy. For some types of complementary and alternative therapies, practitioners go through rigorous standardized training. For others, there may be no formal training. Sometimes there may be formal training but the profession is not regulated. Not being regulated means that:

  • A given title is not protected by law and can be used by anyone, even without any training.
  • The profession is not overseen by a regulatory body that protects the public.

Medical doctors, nurses, pharmacists, dietitians, and many other health care professionals are all regulated professionals. Regulatory bodies regulate professions in the public interest. That includes ensuring the necessary training has been completed, registering the professional and making them accountable to this body, and ensuring professional practice and recourse should misconduct occur.

What if you want your child to try a complementary or alternative therapy?

Before you try anything your child’s doctor has not recommended, you should discuss it with the doctor. Some alternative therapies might be harmful for your child or potentially interact with conventional treatment. It is important that you and the doctor properly research these approaches and determine the risks and benefits. This will help you make an informed choice as to whether it is something worth considering.

Be particularly skeptical of treatments that promise amazing results or that are billed as "scientific breakthroughs" or "miracle cures." If a treatment were indeed so powerful, you would not be reading about in on a commercial website or in an ad in the newspaper. Check out the science behind the treatment. If the literature is vague and does not refer to controlled testing on significant numbers of patients, it is not reliable. Many advertisements rely on one or two personal stories (anecdotes). It is also critical to determine whether the treatment is safe and likely to have any side effects.

Open communication with your child's doctor is critical. Research has shown that many patients do not inform their physician or other health care practitioner that they are using CAM therapies because they fear a critical response or feel it is not their business. This may expose them to significant risks.

Will the hospital provide a complementary or alternative therapy?

In deciding whether to consider the use of any complementary and alternative therapies, members of the health care team must place the patient's best interests first. Respecting your needs and wishes is important, but it is secondary to concerns about basic safety. This means that if the doctor or team is not convinced of a treatment's efficacy, and it does not meet evidence-based standards, they may discourage its use. Sometimes parents see hope but the medical team sees suffering.

Many hospitals are developing policies on complementary and alternative therapies, simply because there is increasing interest in it on the part of the general public. Having a policy in place helps provide direction for integrating complementary and alternative therapies into the overall care of a child when members of the health care team, such as the responsible physician, assess this to be safe and appropriate. Some hospitals are actively supporting research into complementary and alternative therapies.

 

Beverley Hales, BScPhm, MHSc

Andrew James, MBChB, MBI, FRACP, FRCPC

12/11/2009


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